Blood Screening Research Articles

KITD816V mutation in blood for the diagnostic screening of systemic mastocytosis and mast cell activation syndromes.

Current diagnostic algorithms for systemic mastocytosis (SM) rely on the detection of KITD816V in blood to trigger subsequent bone marrow (BM) investigations. Here, we correlated the KITD816V mutational status of paired blood and BM samples from 368 adults diagnosed with mast cell activation syndrome (MCAS) and mastocytosis and determined the potential utility of investigating KITD816V in genomic DNA from blood-purified myeloid cell populations to increase diagnostic sensitivity. In a subset of 69 patients, we further evaluated the kinetics of the KITD816V cell burden during follow-up and its association with disease outcome. Our results showed a high correlation (P< .0001) between the KITD816V mutation burden in blood and BM (74% concordant samples), but with a lower mean of KITD816V-mutated cells in blood (P= .0004) and a high rate of discordant BM+ /blood- samples particularly among clonal MCAS (73%) and BM mastocytosis (51%), but also in cutaneous mastocytosis (9%), indolent SM (15%), and well-differentiated variants of indolent SM (7%). Purification of different compartments of blood-derived myeloid cells was done in 28 patients who were BM mast cell (MC)+ /blood- for KITD816V, revealing KITD816V-mutated eosinophils (56%), basophils (25%), neutrophils (29%), and/or monocytes (31%) in most (61%) patients. Prognostically, the presence of ≥3.5% KITD816V-mutated cells (P< .0001) and an unstable KITD816V mutation cell burden (P< .0001) in blood and/or BM were both associated with a significantly shortened progression-free survival (PFS). These results confirm the high specificity but limited sensitivity of KITD816V analysis in whole blood for the diagnostic screening of SM and other primary MCAS, which might be overcome by assessing the mutation in blood-purified myeloid cell populations.

Symptoms: Sudden Hearing Loss and Aural Fullness

Symptoms: Sudden Hearing Loss and Aural Fullness

Improved reverse transcription-recombinase polymerase amplification assay for blood mRNA screening: comparison with one-step RT-qPCR assay

mRNA profiling is effective for body fluid identification because of its sensitivity, specificity, and multiplexing capability. Body fluid mRNA markers can typically be detected using RT-qPCR, RT-PCR followed by capillary electrophoresis, or targeted RNA sequencing. However, due to the multiple handling steps involved, the analysis of many forensic samples using these methods requires time and effort. Here, we describe a rapid and simple method for detecting the blood mRNA marker hemoglobin β (HBB), intended for use in screening before definitive blood identification. We employed a reverse transcription-recombinase polymerase amplification (RT-RPA) assay that can detect target mRNA within 20 min in a single tube. For comparison, we used a one-step RT-qPCR assay. We optimized the RT-RPA assay and found that it could detect HBB from 10−3–10−4 ng of leukocyte RNA and approximately 10−3 µL of blood. The sensitivity was 10-fold lower than that of the one-step RT-qPCR assay but higher than that of the comprehensive analysis methods for definitive blood identification. Thus, the rapidity and sensitivity of the RT-RPA assay support its use as a screening tool. We also found that the RT-RPA assay was highly tolerant to common inhibitors such as humic acid, hematin, tannic acid, and melanin. Considering the inhibitor tolerability, we integrated a simple lysis method (addition of TCEP/EDTA and heating at 95 °C for 5 min) without the RNA purification process into the RT-RPA assay. This direct assay successfully detected HBB in crude blood samples. Our findings suggest that the RT-RPA assay for HBB is a promising strategy for mRNA-based blood screening.

Avoiding Daratumumab Interference with Blood Typing

Background Daratumumab is an IgG monoclonal antibody that binds CD38 on hematopoietic cells and induces apoptosis. It is FDA approved for upfront treatment of systemic light chain amyloidosis as well as treatment of frontline and relapsed/refractory multiple myeloma. Daratumumab, similar to other CD38 monoclonal antibodies, interferes with blood compatibility testing by causing panagglunination on the Indirect Antiglobulin Test (IAT) leading to false positive results and delays in blood availability for transfusion. This panagglutination can persist up to 6 months after the last Daratumumab infusion. Additionally, attempts to overcome this may mask the presence of a clinically significant antibody resulting in acute or delayed hemolytic transfusion reactions. Several laboratory techniques like RBC genotyping, phenotyping, and the use of Dithiothretol (DTT) treatment of serum are used to overcome this laboratory abnormality. These are either technically time consuming or not widely available in all healthcare institutions. DTT, though readily available, requires prior notification of the blood bank when a patient who is being treated with Daratumumab needs a transfusion. This labor intensive and time consuming process may result in delays in patient care adverse outcomes. By far, the most cost effective way is to obtain blood type and antibody screen (IAT) prior to the initial Daratumumab administration. However, this requires institutional strategy (policy, procedure and pathway) for all potential patients starting anti CD38 monoclonal antibodies in general and daratumumab in particular, to allow timely typing and screening of blood in preparation for future transfusion needs. This quality improvement project was instituted to obtain a type and screen (T&S) prior to patients starting Daratumumab in order to champion high value healthcare which balances clinical benefit with costs and harms with the ultimate goal of improving patient outcomes. Methods and Results We retrospectively identified 32 patients who received their first Daratumumab infusion or subcutaneous injection from 11/1/2017 to 5/31/2020 at Community Medical Centers and Community Cancer Institute in Clovis, California and Fresno, California. 13 patients did not have a T&S done within 30 days prior to initiation of Daratumumab, which translates to 40.6%. We conducted manual chart of all patients prior to the intervention and found 6 patients without prior T&S who required transfusions after starting Daratumumab. Each transfusion was regarded as an event regardless of the units of blood received. We calculated the time from T&S order to receipt of transfusion. In total, there were 15 events which amounts to 1,5990 cumulative minute, with the average time to transfusion (TTT) being 1066 minutes. There were also 6 patients with T&S performed prior to Daratumumab initiation who had a total of 22 transfusion events that took 20417 minutes. The average TTT for this group is 928 minutes. The difference in average TTT between patients who had T&S and those that did not have T&S is 138 minutes, which can be clinically significant. We implemented a T&S as part of "Day 0" in our chemotherapy orders in December 2020. 17 patients received their first Daratumumab from January 2021 to January 2022. 15 patients (88%) had T&S performed and 2 patients did not as they were patients from out of network providers. Conclusion We are continuing to gather additional data to see if this improvement results in a decrease in average TTT post implementation. This is quality improvement project represents a major step in reducing delays in blood compatibility testing due to Daratumumab. There are no significant changes in resource utilization since patients who need transfusions will require a T&S to be done regardless. Ensuring that a T&S is performed antecedent to the first Daratumumab treatment will reduce delays in obtaining matched blood products for our myeloma patients. This supports timely transfusions to lower adverse outcomes associated with anemia due to chemotherapy and multiple myeloma.

Insights on 21 Years of HBV Surveillance in Blood Donors in France.

Hepatitis B virus (HBV) infection is the most frequent viral infection found in blood donors (BDs) in France. We analyzed the epidemiological and sero-molecular data on HBV infection gathered over the past two decades by the French haemovigilance surveillance network, blood screening laboratories, and the national reference center for transfusion infectious risks (NRC). Between 2000 and 2020, 6149 of the 58,160,984 donations (1.06/10,000) tested HBV positive, 98% of them from first-time blood donors (FTBDs). In addition, 2212 (0.0071%) of the 30,977,753 donations screened for HBV DNA tested DNA positive, of which 25 (1.1%) were positive only for this marker. HBV prevalence decreased by 2.8-fold and the residual risk for transfusion-transmitted HBV infection decreased 13-fold and was divided by 13. The major risk factor for HBV infection was the origin of donors (endemic country, 66.5%), followed by parenteral exposure (10.7%). In the whole HBV-positive BD population, genotype D was predominant (41.8%), followed by genotypes A (26.2%) and E (20.4%), reflecting the geographical origin of donors. The low and decreasing prevalence and incidence of HBV infection in French BDs, coupled with a screening strategy using three HBV markers (HBsAg, anti-HBc and DNA), ensures a high level of blood safety, further reinforced by the implementation of pathogen-reduction measures.

Blood Donation Screening of Transfusion-Transmissible Viral Infection Using Two Different Nucleic Acid Testing (NAT) Platforms: A Single Tertiary Care Oncology Centre Experience.

Nucleic acid testing (NAT) is used to screen transfusiontransmittable infections (TTIs) in donated blood samples and provide an additional layer of blood safety. In this study, we describe our experience in screening viral TTIs using two formats of NAT: cobas® MPX2 polymerase chain reaction- based minipool NAT (PCR MP-NAT) and Procleix Utrio Plus transcription-mediated amplificationbased individual donor-NAT (TMA ID-NAT). Data routinely collected as a part of blood bank operations were retrospectively analysed over a period of 70months for TTIs. Blood samples were initially screened for HIV, HBV, HCV, syphillis by chemiluminescence and malaria by Rapid card test. In addition to serological testing, all samples were further screened by TMA-based ID-NAT (ProcleixUltrio Plus Assay) during Jan 2015-Dec 2016, and by PCR-based MP-NAT (Cobas® TaqScreen MPX2) during Jan 2017-Oct 2020. RESULTS: A total of 48,151 donations were processed over 70months, of which 16,212 donations were screened by ProcleixUtrio Plus TMA ID-NAT and 31,939 donations by cobas® MPX2 PCR MP-NAT. Replacement donors and male donors outnumbered voluntary donors and female donors respectively. The overall NAT yield rate of MP-NAT was 1:2281 compared to 1:3242 with ID-NAT, during the respective time period. ID-NAT detected 5 HBV infections missed by serology, whereas MP-NAT detected 13 HBV infections and 1 HCV infection missed by serology. The proportion of donations that were both seroreactive and NAT reactive was higher with MP-NAT (59.8%) compared to ID-NAT (34.6%). Cobas® MPX2MP-NAT had higher overall NAT yield rate compared to ProcleixUtrio Plus ID-NAT and confirmed a higher proportion of seroreactive donations. Due to the ease of operation, simple algorithm, cobas® MPX2 PCR based MP-NAT can be an effective solution for blood screening in India.

Hepatitis B virus and other transfusion-transmissible infections in child blood recipients in Lao People’s Democratic Republic: a hospital-based study

IntroductionChildren requiring multiple blood transfusions are at high risk of transfusion-transmissible infections (TTIs). Lao People’s Democratic Republic is a low-resource setting where donor blood screening faces challenges. This study aimed...

Health Literacy, Health Numeracy, and Cancer Screening Patterns in the Zuni Pueblo: Insights from and Limitations of "Standard" Questions.

American Indians experience disparities in cancer screening, stage at disease diagnoses, and 5-year cancer survival. This study investigates how health literacy and health numeracy may be linked to cancer screening behaviors of Zuni Pueblo members using a survey exploring screening behaviors related to breast, cervical, and colorectal cancers. As part of a larger community-based cancer prevention and control project, Zuni Health Initiative staff conducted surveys from October 2020 through April 2021 of 281 participants (men ages 50-75 and women ages 21-75) from the Zuni Pueblo. Bivariate and multivariable analyses investigated associations between health literacy/numeracy measures and cancer screening behaviors. Bivariate analyses showed some associations between distinct measures of health literacy/numeracy and colorectal cancer (CRC) screening, including both colonoscopy (health literacy) and fecal occult blood testing (FOBT) (health numeracy), as well as cervical cancer screening (health literacy). There were no statistically significant associations between health literacy/numeracy measures and mammogram screening for breast cancer. In multivariable analyses, there were no consistent patterns between health literacy/numeracy and screening for any cancer. There are some individual findings worth noting, such as statistically significant findings for health numeracy and FOBT (those reporting lower health numeracy were less likely to report FOBT). An important finding of this study is that questions used to assess health literacy/numeracy did not identify associations aligned with previous research. We reflect on the ways the "standard" questions may not be sufficiently tailored to the Zuni experience and may contribute to health equity barriers.

Gold bipyramids molecularly imprinted gel colorimetric device for whole blood cholesterol analysis

Simple and disposable monitoring of blood is usually the best solution for early clinical diagnosis and home self-inspection of the chronic patients. Herein, a simple point-of-care (POC) device which called molecularly imprinted membrane modified gel colorimetric device (MIMGCD) was prepared for whole blood cholesterol colorimetric detection at the first time. The convenient detection principle of this device rely on molecularly imprinted membranes for specifically separating cholesterol from whole blood firstly, following the gold bipyramids (GBPs) agarose gel system is react with the cholesterol oxidation to product hydrogen peroxide (H2O2), and the cholesterol will be quantified based on the color change. Under optimal conditions, the analytical performance of the proposed device yielded a linear range of 315.8–6000.0 μM and detection limit of 94.7 μM with 6.89% RSD for cholesterol, which can meet the needs of the detection of normal cholesterol content in the human body. Compared with the traditional whole blood detection methods, no complex sample preparation steps or precision instruments are required, endowing MIMGCD with the merits of easy to operate and low-cost. In addition, the multicolor variation of GBPs in the device allow a colorimetric card-like detection mechanism, which can be used for home self-inspection. This device has the potential to be utilized in clinical and home POC testing application for whole blood biomolecule analysis, thereby facilitating the whole blood screening and long-term monitoring in non-specialized laboratory infrastructure.

Mild hyperphenylalaninemia (hpa) presenting as orthostatic tremor: a case report

BackgroundOrthostatic tremor (OT) is a type of postural tremor of the lower extremities that has not been described in either phenylketonuria (PKU) or hyperphenylalaninemia (HPA). Because little is known about the clinical features and therapeutic responses of OT in mild HPA, we describe a mild HPA patient who presented with OT as an initial symptom.Case presentationA 22-year-old male was admitted for bilateral leg tremor while standing, with symptom onset eight months prior. One month before admission, the tremor disappeared in the left leg but persisted in the right leg. Electromyography recorded from the right gastrocnemius revealed a 6–8 Hz tremor, which appeared when the patient was standing and disappeared when he was resting or walking. Blood screening showed a phenylalanine/tyrosine ratio of 2.06 and a phenylalanine level of 140 μmol/L. Urine metabolic screening was negative. Whole-exome sequencing confirmed the presence of a compound heterozygous mutation, c.158G > A and c.728G > A, in phenylalanine hydroxylase (PAH) gene. After three months of levodopa/benserazide tablets (250 mg, tid) and a low-phenylalanine diet treatment, the tremor disappeared.ConclusionsYoung-onset mild HPA is a relatively rare autosomal recessive metabolic disease, and slow OT is a rare clinical feature. Metabolic screening and genetic testing are the keys to early diagnosis and treatment. For adolescents and young adults, appropriate medication and long-term dietary therapy remain important treatments. This case expanded the disease spectrum of slow OT.

Potential of blood exosomal ENAH, SEPT9, EGF, MMP-9 and CXCL8 for the early screening of breast cancer.

Exosomal contents have been recognized as candidate biomarkers for cancer screening and prognosis. The current study aimed to evaluate the potential of the expression levels of exosomal enabled homolog (ENAH), septin 9 (SEPT9), epidermal growth factor (EGF), matrix metalloproteinase-9 (MMP-9) and C-X-C motif chemokine ligand 8 (CXCL8) in the blood for the early screening of breast cancer. Therefore, exosomes were extracted and purified from the peripheral blood of 47 patients with breast cancer, 63 disease controls (DCs) and 33 healthy controls (HCs). Subsequently, the exosomal mRNA expression levels of ENAH, SEPT9, EGF, MMP-9 and CXCL8 were detected by reverse transcription-quantitative polymerase chain reaction. The results showed that the exosomal levels of ENAH and EGF were significantly higher in patients with breast cancer compared with DCs and HCs (both P<0.001). In addition, receiver operating characteristic curves revealed that exosomal ENAH was able to discriminate patients with breast cancer from DCs [area under the curve (AUC), 0.841] and HCs (AUC, 0.859). However, exosomal EGF was only able to discriminate patients with breast cancer from HCs (AUC, 0.776). Furthermore, the levels of exosomal SEPT9 were lower in patients with breast cancer compared with DCs and HCs (P=0.021), and exosomal SEPT9 expression levels exhibited good potential in the discrimination of patients with breast cancer from DCs (AUC, 0.717) and HCs (AUC, 0.830). However, no significant difference was detected in exosomal levels of MMP-9 and CXCL8 among the three groups, and these RNAs showed no discriminative ability. In addition, in patients with breast cancer, the exosomal levels of ENAH were associated with molecular subtypes (P=0.010), while those of MMP-9 were associated with a Ki-67 index of ≥30% (P=0.011). In conclusion, the exosomal levels of ENAH, SEPT9 and EGF in blood samples were able to identify patients with breast cancer, thus providing a novel approach for the early screening of breast cancer.

21 (PB-021) Poster Spotlight - Breast Cancer Whole Blood Screening: Analytical and Clinical Performance from Early Analysis of the International Identify Breast Cancer (IDBC) Study

Background: Breast cancer is detected after stage I for many women, particularly women with dense breast tissue and those under 50, due to screening mammography performance and program participation. This report provides data for a new CE-marked blood test currently available in Canada. The test uses a non-fractionated blood sample and involves analysis of a gene expression panel (12 targets) using custom reagents and machine-learning informed software for identification of an active breast cancer signature that has been validated through a retrospective clinical study.

Differentially expressed genes identification and bioinformatics analysis of venous blood in patients with mild preeclampsia

Background: Preeclampsia (PE) is a syndrome characterized by hypertension (systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg) and proteinuria that develops after 20 weeks of gestation. It is classified as mild PE and severe PE. Placental abruption, fetal growth restriction, and fetal death are common complications of PE, which is a serious threat to maternal and infant safety during pregnancy. Bioinformatics analysis can dig into the undiscovered biological information, and have a deeper understanding of the pathogenesis of diseases. At present, the pathogenesis of PE has not been fully studied. There is no information in literature on key gene screening and bioinformatics studies of mild PE. Aims and Objectives: The aim of the study was to explore the differential genes screening and related biological process (BP) in venous blood of patients with mild PE. Materials and Methods: GSE48424 dataset was downloaded from Gene Expression Omnibus database, differential genes were screened. Gene ontology (GO)|Kyoto Encyclopedia of Gene and Genomes (KEGG) enrichment analysis was completed. The protein-protein interaction (PPI) network of differential genes was mapped using STRING and Cytoscape. Identify key modules and genes involved in mild PE. Results: A total of 433 up-regulated and 1242 down-regulated genes were obtained. GO function analysis showed that BP was mainly related to endosome organization, dephosphorylation, and endomembrane system organization. Cellular component is mainly related to promyelocytic leukemia body, nuclear membrane, and nuclear envelope. Molecular function is mainly related to ubiquitin-like protein transferase activity，phosphoric ester hydrolase activity, and phosphatase activity. KEGG showed that differential genes were enriched in sphingolipid, TNF, herpes simplex virus 1 infection, and pancreatic cancer pathway. The PPI network of differential genes was constructed to obtain 10 key genes involved in mild PE: SGMS1, SGPP1, ASAH1, PPAP2C, PPAP2B, PPP1R12A, WDR82, PPP2R2A, PPP4R2, and PPP4R1. Conclusion: Using bioinformatics technology to identify the hub genes involved in mild PE can provide a favorable basis for further study of biological markers and pathogenesis of mild PE.

Automated measurement of malaria parasitaemia among asymptomatic blood donors in Malawi using the Sysmex XN-31 analyser: could such data be used to complement national malaria surveillance in real time?

BackgroundThe recent worldwide increase in malaria cases highlights the need for renewed efforts to eliminate malaria. The World Health Organization advocates that malaria surveillance becomes a core intervention. Current methods to estimate the malaria burden rely on clinical malaria case reports and surveys of asymptomatic parasite infection mainly from children < 5 years. In this study the hypothesis was that screening blood donors for malaria parasites would provide real-time information on the asymptomatic reservoir of parasites in the adult population and mirror other surveillance data.MethodsThis study was conducted in Malawi, a high malaria burden country, at the Malawi Blood Transfusion Service, which collects blood units at donation sites countrywide. A secondary analysis was conducted on data obtained from a prior Sysmex XN-31 analyser malaria diagnostic evaluation study utilizing residual donor blood samples. XN-31 malaria results, donor age, sex, geographical location, and collection date, were analysed using standard statistical methods.ResultsThe malaria parasite prevalence in blood donors was 11.6% (614/5281 samples) increasing seasonally from December (8.6%) to April (18.3%). The median age was 21 years and 45.9% of donors were from urban areas, which showed a lower prevalence compared to non-urban regions. The Central administrative region had the highest and the Northern region the lowest malaria parasite prevalence. The donors were predominantly male (80.2%), 13.1% of whom had malaria parasites, which was significantly higher (p < 0.0001) than for female donors (7.4%). Multivariable logistic regression analysis showed that age, location, and collection month were significant predictors of malaria positivity in males, whereas in females only location was significant. There was no gender difference in parasite density nor gametocyte carriage.ConclusionsThis study demonstrates the powerful utility of screening blood donors for malaria parasites using the XN-31, which not only improves the safety of blood transfusion, but provides valuable complementary surveillance data for malaria control, especially targeting males, who are generally excluded from periodic household surveys. Blood donations are sourced countrywide, year-round, and thus provide dynamic, real-time information on the malaria burden. Furthermore, the XN-31 identifies the asymptomatic human reservoir of infectious gametocytes, which must be targeted to eliminate malaria.

Complete coverage by examinations: relationship to colorectal cancer burden and the COVID-19

Abstract Background Colorectal cancer (CRC) is among the most common cancers and cancer causes of death worldwide. CRC screening and early detection is essential to reduce CRC incidence and mortality. CRC screening has been initiated in the Czech Republic in 2000 for persons over 50 and currently offers a faecal occult blood test (FOBT) or screening colonoscopy (CS). The aim of our study was to present complete coverage by examinations in relation to the trends in CRC burden and impact of COVID-19. Methods We defined the complete coverage by examinations as the proportion of persons aged over 50 undergoing examination with CRC early detection potential (FOBT or CS for any indication) during past 3 years. Standardized incidence and mortality rates were used to assess epidemiological trends. The impact of COVID-19 was assessed for 2020 and 2021 by comparing the volume of examinations with 2019. We used national health registries (National Registry of Reimbursed Health Services, Czech National Cancer Registry) as the source of data. Results Complete coverage was increasing over time and reached around 50% in recent years (target population is more than 4 million persons, most of the performed examinations were screening FOBT). However, coverage has decreased to 47.9% in 2020. In 2020 and 2021, the number of tests performed decreased by 16.9% and 5.5%, respectively, compared to 2019. CRC incidence and mortality rates have decreased by more than 20% and almost 30%, respectively, in the last decade. Conclusions Complete coverage has reached a satisfactory level and has likely a positive impact on the epidemiological trends. However, further action is needed to increase coverage, recently affected by COVID-19 pandemic, when non-acute health care may have been neglected. Key messages • The long-term high level of coverage by examinations likely has a positive impact on CRC burden. • The observed decrease in coverage caused by COVID-19 needs to be appropriately compensated.

Congress report: Online workshop on assessment of technical files for blood screening in vitro diagnostics for sub-Sahara African countries.

The online workshop on IVD regulation was performed to broaden the understanding of the technical documentation needed for IVD licensing and the strategies to asses it. Testing of blood donors and donations significantly reduces the risk of transmitting transfusion-transmissible infections. Many test systems are commercially available, but not all meet the recommended sensitivity and specificity standards. Many African countries either lack functional structures for the regulation of IVDs this poses a threat to the quality of the blood supply. The Paul-Ehrlich-Institut BloodTrain organised an online workshop in September 2021 to introduce staff from several National Regulatory Authorities (NRAs) in Africa to the regulation of IVD and the technical information that need to be provided by the manufacturers of blood screening IVD. Their evaluation was trained in practical exercises. This online workshop brought together over hundred participants from NRAs of 12 African countries. Speakers from PEI, Blood Train, WHO and academia, with experience in IVD regulation trained participants in the various topics addressed during this workshop. This workshop presented a great starting point for most participating NRAs to set up and/or strengthen their regulatory structures for IVDs.

Sustained remission of psychotic symptoms secondary to hypothyroidism (myxedema psychosis) after 6 months of treatment primarily with levothyroxine: a case report

BackgroundPsychotic symptoms associated with hypothyroidism, also known as “myxedema psychosis,” are a treatable cause of psychosis often associated with complete recovery. While most cases receive both thyroxine and a short course of antipsychotics, some reports indicate that symptoms can resolve without antipsychotic treatment, though follow-up in these cases has often been short or not reported. This is one of the first case reports demonstrating sustained remission of psychotic symptoms at 6 months in a case of myxedema psychosis treated with minimal antipsychotic medication.Case presentationWe describe the case of a 40-year-old Caucasian woman who was brought to hospital with a 7-day history of anxiety and decreased sleep and 1 day of disorganized speech, paranoid delusions, and auditory hallucinations. After being admitted to psychiatry for management, screening blood work revealed elevated thyroid-stimulating hormone. The patient was initiated on treatment with levothyroxine and low doses of antipsychotics. Her symptoms resolved on the third day of her admission with ongoing symptomatic remission at 6 months follow-up.ConclusionsThe identification of myxedema psychosis is important owing to the implications on treatment and prognosis of the disorder. Our case suggests that sustained symptom resolution may occur with little to no antipsychotic treatment, though these findings are preliminary and additional study is needed before definitive conclusions on the optimal approach can be made.

Sexual Behavior and Awareness of Sexually Transmitted Diseases Among Street-Based Female Sex Workers in the Florence Area, Central Italy

Objective: Street-based female sex workers are more likely to practice unprotected sex with multiple partners increases their risk of infection with sexually transmitted diseases. This study was performed to evaluate the understanding of and risk factors for sexually transmitted diseases among street-based female sex workers. Methods: A survey consisted of a sociodemographic section and a health section was conducted from June to August in two consecutive years (2012-2013) using an anonymous questionnaire compiled by street-based female sex workers in the area of Florence (Central Italy). A descriptive analysis of sociodemographic, epidemiological, and anamnestic variables was performed using common methods for proportions; associations between variables were assessed using univariate and bivariate logistic regression. Results: Totally 122 street-based female sex workers (mean age, 24.1 years; age range, 17–45 years) were enrolled, and were from Europe (63.1%) (mainly from Romania [48.4%] and Albania [13.1%]), Africa (31.2%) (specifically Nigeria), and South America (5.7%). Of the 122 street-based female sex workers, 63% were married/engaged and 37% were single. More than half had been living in Italy and Florence for more than 1 year; 72.8% stated that they possessed a residence permit and the others were illegal migrants. Eighteen (15%) street-based female sex workers also worked in the industry in neighboring European countries. Their level of education was generally high: 58.1% had completed secondary school (lower secondary school and upper secondary school). A total of 81.4% stated that they perceived an actual fear of contracting human immunodeficiency virus; in fact, 43.3% had never been tested for any sexually transmitted diseases except for human immunodeficiency virus. Conclusion: Despite the long-time involvement of street-based female sex workers in the commercial sex industry, the large numbers of clients and a strong perception of concerns about sexually transmitted diseases. This study confirms a low rate of condom use and blood screening, and corresponding science education and health screening efforts need to be strengthened in this high risk population.

Increasing participant diversity in AD research: Plans for digital screening, blood testing, and a community-engaged approach in the Alzheimer's Disease Neuroimaging Initiative 4.

The Alzheimer's Disease Neuroimaging Initiative (ADNI) aims to validate biomarkers for Alzheimer's disease (AD) clinical trials. To improve generalizability, ADNI4 aims to enroll 50-60% of its new participants from underrepresented populations (URPs) using new biofluid and digital technologies. ADNI4 has received funding from the National Institute on Aging beginning September 2022. ADNI4 will recruit URPs using community-engaged approaches. An online portal will screen 20,000 participants, 4000 of whom (50-60% URPs) will be tested for plasma biomarkers and APOE. From this, 500 new participants will undergo in-clinic assessment joining 500 ADNI3 rollover participants. Remaining participants (∼3500) will undergo longitudinal plasma and digital cognitive testing. ADNI4 will add MRI sequences and new PET tracers. Project 1 will optimize biomarkers in AD clinical trials. ADNI4 will improve generalizability of results, use remote digital and blood screening, and continue providing longitudinal clinical, biomarker, and autopsy data to investigators.

Congenital hypothyroidism in India: A systematic review and meta-analysis of prevalence, screen positivity rates, and etiology.

Congenital hypothyroidism (CH) is the leading cause of preventable mental retardation, which is currently not universally screened in India. Knowledge of the country-specific prevalence of the disease can guide in establishing a universal screening program. We performed a systematic review and meta-analysis to assess the prevalence, screen positivity rates, compliance to recall and etiology of CH in India. The databases of PubMed, Embase, Google scholar and IMSEAR were searched on 1st October 2021. All observational studies reporting at least one of the outcomes of interest were included. Two reviewers independently extracted the data and appraised the quality of studies using the Joanna Briggs tool for prevalence studies. Estimates were pooled using a random-effects model with double arcsine transformation (MetaXL software). PROSPERO database registration number was CRD42021277523. Of the 2 073 unique articles retrieved, 70 studies were eligible for inclusion. The prevalence of CH (per 1 000 neonates screened) was 0·97 (95% confidence intervals/CI: 0·9, 1·04) in non-endemic areas (54 studies and 819 559 neonates), 79 (95% CI: 72, 86) in endemic areas (3 studies, 5 060 neonates), 50 (95% CI: 31, 72) in neonates born to mothers with thyroid disorders, and 14 (95% CI: 8, 22) in preterm neonates. At thyroid stimulation hormone cut-off of 20 mIU/L, the screen positivity rates were 5·6% (95% CI: 5·4%, 5·9%) for cord blood samples and 0·19% (95% CI: 0·18%, 0·2%) for postnatal sample. About 70% (95% CI: 70, 71) of screen positive neonates were retested with diagnostic tests. Among neonates with permanent hypothyroidism, thyroid dysgenesis 56·6% (95% CI: 50·9%, 62·2%) was more common than dyshormonogenesis 38·7% (95% CI: 33·2%, 44·3%). The prevalence of congenital hypothyroidism in India is higher than global estimates. Screen positivity rate was higher for cord blood screening when compared to postnatal screening. Compliance with confirmatory testing was higher for cord blood screening. The study was not funded by any source.